HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1�
Date: Permit Number:
RECEIVED
Building Permit Application JUL 2 7 2018
Planning and Development Services
Building and Code Regulation Division ST, Lucle County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical J
PIROPOSED IIM'PR;OVEM!ENT LOCATION:
Address: 5612 MYRTLE DRIVE, FORT PIERCE, FL 34982
Legal Description. INDIAN RIVER ESTATES UNIT 08
Property Tax ID#: 3402-609-0319-000-1 Lot No. 1.2 AND 21
Site Plan Name: Block No. 61
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
KW 7
TON 3
SEER 14
FcONSTRUCTIGN INFORMATION:
Additional work to be nprtormed under t ispermit—check all appy:
❑HVAC Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: 1141 SFt. of First Floor:
Cost of Construction:$ 4400.00 UtilitieslnSewer❑Septic Building Height:
OWN'ERAE`SSEE: CONTRACTOR:
Name ESTHELLA PHILLIPS Name: MARK A VINES
Address: 5612 MYRTLE DRIVE Company: AZTIL
City: FORT PIERCE State: FL Address: 2540 S MILITARY TRAIL
Zip Code: 34982 Fax: City: WEST PALM BEACH State:FL
Phone No. 772-882-9387 Zip Code: 33415 Fax:
E-Mail:RESELLER@GMX.US Phone No. 561-433-2197
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITS@AZTILAC.COM
from the Owner listed above) State or County License. CAC049253
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
`S'UIPIP+LIEIM!EINTiAL'CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:ESTHELLA PHI LLI PS Name:MARK AVINES
Address: 5612 MYRTLE DRIVE,FORT PIERCE,FL 34982 Address: 5612 MYRTLE DRIVE
City: FORT PIERCE State: City: WEST PALM BEACH State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:2540 S MILITARY TRAIL Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the ' s inspection. If you intend to obtain financing, consult with lender or an attorney before
comm in ork or recordin our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFPALM BEACH COUNTY OF PALM BEACH
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 27 day of JuLY 20_ by this 27 day of JuLY 20_ by
MARK A VINES MARK A VINES
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced dentification
Type of Identification Type of Identificatio
Produced Produced
(Sig a of No - (Signature Not lic I a
Notary Public State of Florida
CO mISSIOn O. �o John Edy�¢l�ifford Commis On o P% Notary Pubfi)�c�.S't a of Florida
y Comm ssion GG 147815 John EdvMM ord
oc h Expires 12/17/2021 i My Commission GG 147815
of a Expires 12!1712021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17